First, there must be trust

Eliud Medina has no buses that roll at his command, no rescue teams, radio stations or legal authority to order quarantine or evacuation. But if disaster, terrorism or epidemic were to strike his city, the community organizer in Chicago’s multi-ethnic northwest corner believes he has an asset that government officials do not have -- something that may make him more effective than many government leaders at leading people to safety.

People in his community trust him.

“At this time, there is a great deal of distrust in government, period,” especially among low-income residents, Medina says. But the trust Medina says he has built in more than a decade of community organization is a powerful asset. He hopes it will allow him to sway poor Chicagoans to make the right choices in the midst of a major emergency.

As politicians and emergency planners in Los Angeles and elsewhere digest the lessons of the recent hurricanes, especially that of New Orleans’ experience, they are relearning a painful fact about disaster preparedness: unless local leaders have secured the trust of their citizenry -- or have enlisted community leaders that enjoy it already -- even the best-laid emergency plans are doomed to failure.

That is especially true when populations in the path of disaster are poor or come from racial or ethnic minority groups, where distrust of government entities runs more strongly than among the affluent and the white, say researchers.

As a result, people like Medina, who is executive director of Chicago’s Near Northwest Neighborhood Network/Humboldt Park Empowerment Partnership, are expected to become key nodes in the network of public health workers and emergency planners charged with keeping Americans safe when disasters strike. Medina and his organization are part of a demonstration project, underwritten by the W.K. Kellogg Foundation, designed to draw community activists -- particularly in areas with high densities of minorities and the poor -- into disaster planning.

In Hurricane Katrina and its aftermath, thousands failed to comply with evacuation orders, with disastrous consequences. Many who stayed in vulnerable neighborhoods did so because they lacked transportation and money to get out. But many who might have left stayed because they distrusted the government’s predictions, its ability to secure abandoned property and its plans to safeguard evacuees.

The aftermath of Hurricane Katrina has only deepened the suspicions of African Americans -- and of poor people in general -- that the government cannot be trusted to protect them, says Medina.

In a speech from New Orleans on Sept. 15, President Bush announced that the Department of Homeland Security would undertake an immediate review of emergency plans “in every major city in America.” American cities, he said, “must have clear and up-to-date plans for responding to natural disasters, disease outbreaks, or terrorist attack, for evacuating large numbers of people in an emergency, and for providing the food, water and security they would need.”

That review, say experts, will have to assess not only the thoroughness of cities’ plans, but the level of trust -- and compliance -- they are likely to inspire.

Los Angeles Mayor Antonio Villaraigosa last week announced he would form a panel to examine the city’s emergency plans in light of the lessons of Hurricane Katrina. But while Villaraigosa has called L.A’.s among the best in the nation, Ellis M. Stanley, general manager of the city’s Emergency Preparedness Department, last week expressed concern about the city’s ability to communicate with -- and gain the compliance of -- city residents in an emergency. Citing distrust of the government and police in many city communities, Stanley said it would be important to spend time and money to cultivate greater public confidence.

“Bringing people into the training and planning, that’s a must,” says Stanley, who called Los Angeles’ melting pot of cultures a unique challenge for emergency planners.

His office has begun to draw the city’s 85 certified Neighborhood Councils into the emergency planning process. In a recent 4 1/2 -hour meeting in Watts, Stanley said, residents expressed “tremendous frustration” with the images they had seen from New Orleans and complained that they have not been included in planning for disaster at home. “That was some frank and honest discussion,” says Stanley, who noted that Watts residents committed to drafting a neighborhood emergency plan.

In a disaster, says Dr. Roz D. Lasker, director of the New York Academy of Medicine’s division of public health, people who distrust the government “are less likely to follow instructions regardless of what they are” -- and by some measures are half as likely to comply with public health and emergency measures as those who trust the government. Lasker is the principal author of a 2004 study that found that public distrust of government emergency plans is widespread.

In surveys conducted for the study, two in three respondents said they were “moderately” to “extremely” worried that, in an emergency involving a terrorist release of the smallpox virus, government officials might instruct them to take action that is not in their best interests. Those skeptics, in large numbers, said their distrust was rooted in a belief that those officials are “incompetent” (29%), “not completely truthful” (39%), that they “don’t care about me” (7%) or “are out to get people like me” (1%).

The result, the study found: Few would comply with official orders. If instructed by local officials to go directly to a nearby vaccination site, less than one in four said they would “rush to go there.” The rest -- with the exception of 2% who said they would definitely “not go” -- said they would go later or wait to get more information or advice.

Levels of concern and distrust, Lasker found, were significantly higher among Latinos, African Americans, those born outside the U.S., those who lack health insurance and those who have not attended college.

Asked to imagine an emergency involving the terrorist release of a “dirty bomb” -- an explosive device that would scatter high levels of radiation -- almost one-third of respondents said they might defy a police order to take shelter in the building they’re in.

“Very often, when people don’t follow instructions, it’s felt they’re ignorant or recalcitrant or ornery,” says Lasker. “But what is to blame is a planning process that’s completely disconnected from what people face.”

If government planners enlisted the local knowledge and public trust of community leaders, they could lay better plans, draw upon the trust that these community leaders have built, and boost the public’s compliance in an emergency, she says.