The Public Health Crisis Survival Guide: Leadership and Management in Trying Times By Joshua M. Sharfstein
New York, NY: Oxford University Press; 2018
232 pages; $39.95 paperback
ISBN: 9780190697211
Joshua Sharfstein blends his experience as a city, state, and federal public health official as well as a congressional staff member with print and digital primary and secondary sources to inform and instruct readers about preventing, identifying, sometimes creating, and—most importantly—managing public health crises. His central theme is that “whether health leaders are successful in their positions often depends on how well they handle a crisis.”(p3) “At the heart of every crisis,” he explains, is “a perception of vulnerability, a whiff of panic, a recognition that there’s more at stake for an agency and its leader than meets the eye.”(p5) Moreover, “a ‘crisis’ for a health agency need not even be related to a genuine health problem.”(p5)
But this book is much more than just a practical manual, as the words “Survival Guide” in the title may suggest. Rather, Sharfstein tells stories about past and recent public health crises in the United States and draws lessons from them in 11 chapters divided into three sections titled “History,” “Management,” and “Strategic Considerations.” He concludes the book with seven appendices in point, each of which has been published previously and six of which are articles he wrote. One of the few technical flaws in the book is that he identifies the journals in which these articles appeared but does not provide publication dates and pages.
FOUR ICONIC CRISES
The purpose of the section on history is to enable readers to “appreciate four iconic crises of the last century.”(p17) These crises were:
[(1) the] national panic over deaths caused by the Elixir Sulfanilamide in 1937 . . . [2] a global calamity in 1961 involving thousands of severe birth defects caused by the medication thalidomide . . . [3] the swine flu debacle of 1976 [which] still haunts vaccine policy decades later . . . [and (4)] how effective advocacy during the HIV epidemic in the late 1980s caused a profound crisis in confidence for the Food and Drug Administration and the National Institutes of Health.(p17)
He relies almost entirely on well-regarded secondary sources in describing these crises and lessons from them. The only technical errors we found in these chapters were his misnaming David Sencer, director of the Centers for Disease Control during the swine flu crisis, as Jeffrey(p40) and not identifying the recipient of an influential 1979 memorandum by Sencer that “recommended a mass vaccination effort led by the federal government.”(p42)
COMPONENTS OF CRISIS MANAGEMENT
In the three chapters in the section on management, Sharfstein summarizes scholarship and his experience of “four core components of crisis management.”(p59) These components are (1) “recognizing and defining a crisis,” (2) managing it, (3) “communications and politics,” and (4) “pivoting from direct crisis management to lasting policy change.”(p59) Sharfstein’s discussion of these components will inform newcomers to the professions of public health and stir memories of triumph and disappointment among veterans in the field (the authors of this review, for example). His most penetrating point in this section, as well as, perhaps, the most significant practical point in the book, is that “public health leaders who fail at political tasks are not quite up to the job.”(p94)
STRATEGIC CONSIDERATIONS
Sharfstein concludes the book with two chapters on strategic considerations that supplement his discussion of history and management. In the first, he discusses “responsibility and blame” and describes how “a strategic approach can help health officials weather the storm.” In the second, he discusses “how leaders can purposefully awaken a sense of crisis to address significant health threats in their communities.”(p129)
Sharfstein ends his final chapter with a summary that is also an exhortation. The book, he writes, demonstrates that “addressing crises is as central to the history of public health as any other aspect of our field.” Moreover, “skills to engage with crises can be studied, practiced, and improved over time.”(p166)
Importantly, Sharfstein’s book is engaging, informative, and thought provoking—as close to a page-turner as a professional publication can be. As a result, it could become foundational in the education and continuing education of public health professionals; it should.