Some might find it useful to set the 9/11 attack in cultural terms, for example into Huntington's ‘civilisation paradigm’.1 However, one has to wonder if that symbolic attack on capitalism and the nature of the West's response might give us some clues as to why the current revolutions in the Middle East are occurring. Part of the response to 9/11 has been to try to keep a lid on unrest by supporting the likes of Mubarak and Gadaffi. Until now, from a Western perspective, that response has ‘succeeded’. What damage it did to the health and wellbeing of the peoples of these countries is only now becoming apparent. It will be of great interest to see what choices these peoples make for their future societies. The adverse health effects of the inequalities and individualism of neoliberalism suggest that, globally, some new political economy is needed. Will what emerges from these revolutions be more genuinely democratic, more egalitarian and more communitarian than the system of political economy which was attacked with the Twin Towers on 9/11?
Many have looked to Latin America for some guide to what sort of economic system might emerge post neo-liberalism. Again, we can only speculate as to the extent to which developments on that continent in the past decade have been influenced by 9/11.
The two most ‘tangible’ public health ‘outcomes’ of 9/11 are the wars in Afghanistan and Iraq, with estimates of the deaths varying from 120,000 to more than 900,000. Whichever figure is accurate, it is many times the 3,400 deaths in the Twin Towers. The breadth of this range is noteworthy, especially as the numbers of US and coalition troops killed are known precisely. Terrorism and the ‘war on terror’ are now a part of everyone's life on the planet. The politics of fear has created an ultra-conservative world with wide ramifications: the creation of more refugees; the increasingly fearful response to more and more refugees; more racism, especially towards Muslims; and a divided planet when, with the threat of global warming, we desperately need a united planet. Such fear is a public health phenomenon in its own right.
Aileen Plant2 wrote of the importance of ‘preparedness’, the public health policies of being well prepared for the possibility of some major outbreak of disease. In Plant's case, the emphasis was on infectious diseases. In the post 9/11 world, there is a preparedness around terror outbreaks but again with a concern that these might prove to be ‘infectious’.
With infectious diseases, there is at least a reasonably well-established generic epidemiological response. That is not the case for terrorism and much of the time since 9/11 has been spent in learning how to respond to and control terrorism. But do we yet know? There have been successes in dampening down ‘spot fires’, but what of preventing ‘bush fires’ breaking out in the first place?
In responding to terrorism, there are two main camps. The first, the road well travelled, is about protecting ‘us’, i.e. the West. The second, where there has been much less emphasis, is about the global community looking to the reasons behind terrorism.
The past decade in public health has seen debate on inequality and health and, in turn, the question of inequality of what – income or class. I tend to agree with Navarro3 and go with the latter where the focus is on powerlessness, lack of autonomy, not being able to choose the life desired.
Terrorism to me is a product of powerlessness. Let me quote Orhan Pamuk,4 writing a month after 9/11: “Today an ordinary citizen of a poor, undemocratic Muslim country, or a civil servant in a third-world country or in a former socialist republic struggling to make ends meet, is aware of how insubstantial is his share of the world's wealth [and] he senses … that his poverty is to some considerable degree the fault of his own folly and inadequacy, or those of his father and grandfather. The Western world is scarcely aware of this overwhelming feeling of humiliation that is experienced by most of the world's population …”
He wrote in that same article of how, having just watched the felling of the Twin Towers on TV, as he walked the Turkish streets, he met one of his neighbours who said: “Sir, have you seen, they have bombed America,” and added fiercely, “They did the right thing.”
What we in the West have failed to do in the post 9/11 world is to acknowledge that humiliation. Too seldom have we had that great gift ‘to see ourselves as others see us’. That continued ability to fear the different rather than embrace and celebrate diversity has not been good for the health and wellbeing of the global community. ‘Humanitarian’ overseas aid, for example, is more and more about our security rather than their humanity.
Methodologically in public health we have had to learn from 9/11, for example that public health has to “encompass a broader array of determinants of health than [it] has previously addressed”.5 Disaster management has grasped that “innovative early post-disaster interventions that may be easily accessed by the general population may be particularly important after future disasters”.6