If You Can’t Stand the Heat, Prepare for It Anyway

My second job at CDC was running policy for the chronic disease center. I was covering familiar and predictable topics: slow-moving threats that we all have experienced in our families, from cancer to arthritis to tobacco.

This position was a retreat, of sorts. My first job at CDC seemed benign: policy analyst in the office of the CDC director. The summer of 2001, I learned how CDC developed its recommendations for the President’s Budget, how we analyzed bills before the US Congress, and how to prepare the director for speeches. On September 11, everything changed. The agency and the whole country were thrown into a new world, one without the Twin Towers and without the security we had taken for granted.

Next, the US had its first biological weapon attack, and it was this CDC response that changed the agency. There was the immediacy of tracing the anthrax spores and the disease and death they caused. There was deep involvement with law enforcement and the media. There was the large deployment of countermeasures, like vaccines and antibiotics. My job was mostly to answer questions from policymakers in Congress and the Bush Administration. I wasn’t saving lives, exactly, but I was in the middle of the action.

Preparing for the Worst

It’s hard to remember the fear and uncertainty of that time, but I know it changed my career. After terrorist attacks and a biological attack that we didn’t yet understand, CDC and other agencies stepped up their efforts to plan for the worst. What if there were more anthrax attacks, with wide disbursement of deadly spores? What if botulinum toxin got into the water supply? What if smallpox was seeded in the population?

One day, I was gathering information for yet another Congressional question about our emergency preparedness in an expert’s office, with pictures of children with smallpox all around us. That night, I came home to my two-year-old son and felt the fear that all this preparation was instilling in me. That’s when I switched to working on chronic disease.

CDC continued to prepare without me. The US government made big changes and investments to be more prepared for health emergencies. But some of us didn’t want to face the fears every day.

This avoidance is natural, and I am grateful that so many leaders overcame it to seize the moment. Most of us don’t want to dwell in worst-case scenarios or rehash the worst moments of our lives and careers. But as health leaders, we have an obligation to do just that.

Leading in Crisis

I was with Milbank Fellows last month in Chicago, where we spent time thinking about state health leaders’ legacies. We all have plans for what we want to build for our communities and organizations. No one plans to be defined by a tragedy, and yet, when I think about where I’ve made the biggest impact, it’s been in emergencies. And that is true for so many public servants. Being prepared and responding well are critical to serving, even though we can’t know when or how we will be called to lead in crisis. When leaders can’t meet these moments, they can lose the legacies they’ve built.

Yet, emergency preparedness is hard to face…especially for the COVID-response weary, which I dare say includes all of us. Learning from that response — as long and fraught as it was — is necessary, but not easy. Current outbreak responses show that we have actually lost ground in federal and state coordination and in communicating threats to the public.  So far, hantavirus and Ebola directly affect very few Americans, yet we need to be ready for unusual threats. But some threats are almost certain to be realized.

Preparing for Expected and Unexpected Threats

This month, Milbank partnered with the Common Health Coalition and Johns Hopkins University Bloomberg School of Public Health researchers on a brief that examines the health and economic impact of heat emergencies, as well as how to improve state and local preparedness for them. Our estimates show that a single moderate heat wave in one state can kill 300 people, lead to 4,000 emergency department visits or hospitalizations, and cost $870 million in medical expenses, lost productivity, and social costs like workers compensation. We know heat events are coming, and we can mitigate their impact with better planning, especially planning that connects the public health and health care systems.

This kind of planning not only improves outcomes for the threats that we know are coming, like heat and other weather events, but also strengthens our muscles for responding to the unknown. No emergency unfolds to match our planning scenarios. Flexibility and strong existing relationships across sectors make those surprises more manageable, leading to more effective responses. Successful emergency responses save lives and money, build trust in government, and ultimately improve population health and health equity, in times when our communities need us most. As leaders, we can focus on what we know is coming to be ready for the emergencies we haven’t yet imagined.

Join Milbank, the Common Health Coalition, and researchers from the Johns Hopkins Bloomberg School of Public Health on Thursday, July 9, at 2 pm ET for a webinar on heat event impacts and cross-sector preparedness.