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| What situations splinter the social trust necessary to cope with health crises, and how might they be defused? |
Breaches of social trust are a common predicament for leaders during outbreaks and are likely to arise during a bioattack. Social and economic fault lines as well as preconceived notions about "the government," "the public," and "the media" can alienate leaders and the public, and community members from one another. Preventing unproductive fear, denial, or skepticism on the part of the public when delivering crisis updates: Case studies:
2001, Mayor Leads Mourning New Yorkers
2001, EPA Reassures Ground Zero Residents that Air Is Safe
- Share what you know. Do not withhold information because you think people will panic. Creative coping is the norm; panic is the exception.
- Hold press briefings early and often to reach the public. Answering questions is not a distraction from managing the crisis; it is managing the crisis.
- Confirm that local health agencies and medical facilities are prepared to handle an onslaught of questions from concerned individuals, in person and by phone.
- Convey basic health facts clearly and quickly so that people have peace of mind that they are safe or so that they seek out care, if need be; similarly, brief healthcare and emergency workers so they have a realistic understanding about job safety.
- View rumors as a normal sign of people's need to make sense of vague or disturbing events. Refine your outreach efforts; the current ones may not be working.
Earning confidence in the use of scarce resources despite existing social and economic gaps: Case study: Polled Americans Expect Discrimination during Smallpox Outbreak
- Account for income disparities in response plans; anticipate the need for free or low-cost prevention and treatment.
- Make planning transparent so that the public sees that access to life-saving resources is based on medical need and not on wealth or favored status.
- Be open about eligibility criteria for goods and services, especially when tough choices arise unexpectedly—for example, which botulism attack victims will receive the limited antitoxin that exists.
- Show thorough preparations to protect vulnerable populations like children and the frail elderly, thus bolstering everyone's sense of security.
Maintaining credibility when decisions must be made before all the facts are in: Case studies:
2001, New York City Health Officials Earn Public Trust
2003, Chinese Leaders Withhold SARS Information from Villagers
- Advise the community at the outset if crisis conditions are evolving or could be prolonged.
- Offer more detail rather than less, even when the unknowns outnumber what is known; resist the urge to reassure for reassurance sake alone.
- Be frank about any uncertainty regarding "facts"; describe plans to fill in knowledge gaps.
- Vary your means of reaching the public. Mix high-tech outreach (internet, cable, network, print, radio, cell phone, automated hotlines) with contact through grassroots leaders.
Agility, Endurance, and Recovery through Collaboration 
| Dynamic, cooperative effort among leaders and residents of a model city helps resolve the immediate health crises, hasten long-term recovery, and promote the ability to weather future adversity. |
| LEGEND | 
| Leaders - Decision-makers—such as the mayor, health commissioner, emergency manager, and police and fire chiefs—ideally discern the "big picture" and tailor their advice and actions accordingly. | 
| Intermediaries - "Connecting" people on a regular basis are everyday settings like workplaces, schools, neighborhoods, and places of worship, as well as the information that is passed along by trusted sources such as family, friends, grassroots leaders, and journalists. | 
| Public-at-Large - Members of the public have only a diffuse impact if individual efforts are not harnessed to one another and if people judge their actions only from their own point of view. At the same time, their broad reach provides a potential safety net for dispersed, vulnerable populations such as children and the non-institutuionalized disabled. | 
| Solution | 
| Context - The city is not self-contained—for example, commuters move between home and work; leaders interact with their counterparts in neighboring jurisdictions; federal authorities lend their support. |
Modeling an Actual City Representative statistics taken from a mid-sized Northeastern U.S. city demonstrate the relative numbers and influence of leaders, intermediaries, and the public. Leaders:
Mayor, Mayor's Cabinet, City Council - 49 Intermediaries:
Schools - 558
Religious Organizations - 675
Community Organizations - 854
News Outlets (print, radio, broadcast) - 39 Public-at-Large:
Total Population - 651,154
Children 19 Years and Younger - 183,207
Non-institutionalized Disabled - 162,044 Context:
Counties and States within 90 Miles - 26
Daily Commuters - 229,526
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