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To Download a PDF of an Interview with Ezekiel Resilience Defi ning Resilience An Interview with Ezekiel J. Emanuel, MD, PhD, Vice Provost for Global Initiatives and Chair of the Department of Medical Ethics and Health Policy, University of Pennsylvania EDITORS’ NOTE Ezekiel Emanuel INSTITUTION BRIEF The University people the opportunity to try again. The erosion is the Vice Provost for Global of Pennsylvania (Penn) is a pri- of the safety net for individuals has undermined Initiatives and the Diane v.S. Levy and vate Ivy League university located in the environmental factors that are key to indi- Robert M. Levy University Professor Philadelphia. Penn (upenn.edu) was vidual resilience. at the University of Pennsylvania. America’s fi rst university, founded by This links individual resilience with institu- He is also an Op-Ed contributor to Benjamin Franklin, and is the fourth- tional resilience. Institutional structures and sup- The New York Times. He was the oldest institution of higher education in ports are necessary for individual resilience. We founding chair of the Department of the United States. It is noted for its schools must not champion resilience and suggest it is all Bioethics at the National Institutes of of business, law, and medicine, each of about individuals fending for themselves, and then Health and held that position until which was the fi rst in North America, and dismiss those who fail as not having resilience. We August 2011. From January 2009 also developed the nation’s fi rst liberal need institutional structures and supports – that until January 2011, he served as arts curriculum. About 4,500 professors secure safety net – for there to be individual resil- a Special Advisor on Health Ezekiel J. Emanuel serve more than 10,000 undergraduate ience and for the notion of resilience not to be a Policy to the Director of the Offi ce and nearly 12,000 graduate and profes- “blame the victim” situation. of Management and Budget and National sional students. Penn is widely recognized as one One thing COVID-19 is revealing about Economic Council. Dr. Emanuel has published of the world’s leading research universities and American public health is the fragility of our fed- over 300 articles in bioethics and health policy, consistently ranks among the top 10 universities eralist approach. Public health has always been and is the most widely published and cited bioeth- in the annual U.S. News & World Report survey. shared between the federal government, states icist in the world. He has also authored or edited and localities. That could be a strength if there a total of 15 books, his two most recent being The How do you defi ne resilience? are overlapping responsibilities and programs that Trillion Dollar Revolution and Which Country I think we need to distinguish resilience fi ll in for each other and duplicate roles so there Has the World’s Best Health Care? He was the of individuals and resilience of institutions and are no cracks for people to fall through. But as lead editor on The Oxford Textbook of Clinical organizations. Resilience of individuals requires COVID-19 has demonstrated, there is no over- Research Ethics. After completing Amherst College, a careful blending of character and environ- lap and plenty of cracks where responsibilities he received his MSc from Oxford University in ment. Resilient individuals need to be able to between the different layers of the government Biochemistry. He received his MD from Harvard persist in the face of adversity and failure. This are not overlapping. Medical School and his PhD in political philoso- character trait often requires early childhood Part of this is funding and, more specifi - phy from Harvard University. In 1987-88, he experience of adversity and encouragement to cally, the miniscule public health funding. The was a fellow in the Program in Ethics and the recover and persist. As a psychiatrist friend has CDC budget is about $12 billion for a popula- Professions at the Kennedy School of Government repeatedly told me, good childhood training tion of 330 million – about $36 per American. It at Harvard. After completing his internship and for resilience is a lot of “near misses.” One of is not possible to have a resilient public health residency in internal medicine at Boston’s Beth the things I worry about is the impact of over- program, including one that is international, Israel Hospital and his oncology fellowship at the protective parents in reducing if not eradicating on such a small funding base. Obviously if we Dana-Farber Cancer Institute, he joined the fac- children’s experiences of adversity and failure – want a resilient public health structure to help ulty at the Dana-Farber Cancer Institute. Dr. and recovery. If children don’t have that adver- people confront adversity like COVID-19, we Emanuel was an Associate Professor at Harvard sity, it is hard to become resilient. need to spend more money. Medical School before joining the National We also need to be aware that the environ- But not everything is money. Resilient orga- Institutes of Health. He has received numerous ment plays a huge role in the ability of individuals nizations require great leadership that clearly awards including most recently the $1 million to persist in the face of adversity. Having a secure defi nes the mission and values of the organization, Dan David Prize for bioethics. He is a member base is important to sallying forth and trying new recruits top talent and gives them opportunity to of the National Academy of Medicine (formerly things and picking yourself up when you fall lead programs consistent with the mission and val- the IOM) of the National Academy of Science, down. People can confront adversity when they ues, and supports them in that even when they the Association of American Physicians, and the know it will not make them destitute or rob them are inevitably criticized and attacked. What we Royal College of Medicine (UK). He received the of all opportunities. have seen over the last year or so are the conse- AMA-Burroughs Welcome Leadership Award, the F. Scott Fitzgerald’s infamous statement quences of a lack of leadership and an undermin- Public Service Award from the American Society that “there are no second acts in America” was ing of competent leadership. of Clinical Oncology, and the John Mendelsohn very, very wrong. One of the great things about This leads me to my final thought: Award from the MD Anderson Cancer Center. In America is that there were opportunities for sec- Resilience itself can be fragile. Institutionally, it 2007, Roosevelt University presented Dr. Emanuel ond acts. The country allowed people to not be requires investment of resources and compe- with the President’s Medal for Social Justice. In permanently defeated and gave them an oppor- tent leadership that knows the core values of 2013, the AMA recognized him with its highest tunity to try again. That is the heart of equal the institution and advances them in the face of bioethics award: the Isaac Hays, MD and John opportunity. One of the things we have lost – adversity. Going forward we need to cultivate Bell, MD Award for Leadership in Medical Ethics or at least signifi cantly diminished – in the last leadership to ensure resilient institutions and, and Professionalism. number of decades is the safety net that allows therefore, resilient Americans.• VOLUME 43, NUMBER 4 POSTED WITH PERMISSION. COPYRIGHT © 2020 LEADERS MAGAZINE, LLC LEADERS 29.
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