When George Esbensen points out — passionately — that firefighters run toward danger, he isn't talking solely about flames. The former Eden Prairie fire chief is on a mission to educate the public, lawmakers and employers about the often unspoken dangers firefighters face: high rates of cancer and heart disease, as well as mental health challenges due to regular appearances on the front line of tragedy.

Esbensen, who retired in 2018 after serving for 16 years as the city's first full-time fire chief, now devotes his energy to the Minnesota Firefighter Initiative, MnFIRE, a nonprofit advocacy organization he helped to found. He talks about its goals and how we can help those who help us.

Q: You created MnFIRE to address what you call an "escalating crisis." Please say more about that.

A: I'd been to many firefighters' funerals and my colleagues and I started noticing patterns. These men and women weren't falling through roofs. They were dying from incredibly high rates of cancer, suicide and cardiac issues.

Q: How high?

A: More than 68% of all firefighters will develop some form of cancer in their lifetime, according to the National Fire Protection Association. Of the firefighters named on the National Fallen Firefighter Memorial Wall of Honor, 55% died from cancer, mostly cancers found in the digestive, respiratory and urinary systems. More than 12% of firefighters will develop heart disease, according to the International Association of Firefighters; cardiovascular disease is, by far, the leading cause of line-of-duty deaths. Research also suggests an association between the number of years of duty in the fire service and higher levels of suicidal ideation or action. Imagine if your vocation, day in and day out, was to serve people who are having their worst possible day. It's not normal.

Q: Why has it taken this long to get people's attention?

A: A big part of it is you have to take the macro view. Ninety-three percent of our state's 20,000 firefighters are non-career firefighters. They're insurance people, lawyers, salespeople, plumbers, electricians, schoolteachers, sometimes even police officers, too. They have spouses and partners, kids and financial stresses of regular human existence. They don't have a lot of extra time to advocate about this issue. Also, there is bias among policymakers to not kick over this issue because it's going to be very expensive to remedy. Minnesota ranks 44th in the nation in per capita fire service spending. That's not true of every community but, as a whole, we're not supporting firefighters in a way that is meaningful. You need to equip them for the battle and what happens afterward.

Q: Because, realistically, these brave souls aren't going to walk away from this work.

A: It's a calling. It's giving back to your community. It's being there at people's worst moments and making it better for them. Firefighters are not people who will spend a lot of time thinking about their own well-being, which is a blessing and a curse.

Q: Did you just describe yourself?

A: I've never had cancer or cardiac issues, but I have gone to really horrific scenes and it takes days to shake it off. Every time you closed your eyes, you'd see those sights. You just couldn't get peace. You need to really have resources to lean into, a safe place to talk to people about the impact, and try to not bring it home.

Q: One sad irony is that some cancers are tied to the gear firefighters wear to protect themselves?

A: Despite many statewide bans on fire retardant chemicals, the presence of existing synthetic materials increases the amount of smoke and toxic gas released. Another danger is the filth that gets all over the gear. Back in the day, it was a badge of honor if your gear was smelly and stinky, but all that is soaking into your skin and you're breathing it in. You're just carrying around carcinogens. When I was new in the fire service, the first thing you did was take off your respirator.

Q: Sounds like education is warranted, quickly.

A: It's about changing the culture, educating chief officers and policymakers and getting more funding for fire departments to provide gear extractors to properly clean firefighters' protective equipment.

Q: What can employers do to help?

A: Adopt a philosophy of taking care of your employees who are also firefighters. That means shifting the burden of proof off them and on to employers and accepting that cancer and PTSD are related to working as firefighters. Make sure that employee assistance programs (EAPs) are available to them. It's unfair to ask people to do this in their spare time and then be up against it with their own insurance provider.

Q: You're taking your mission to the Minnesota Legislature. What's the latest?

A: Our next big push in 2020 is to pass the Hometown Heroes Assistance Program which, in part, will provide funding and resources for diagnosis of cancer or cardiac issues, EAPs, peer counselors, ongoing training and regional centers of excellence. It's a $7 million ask that would go a long way to improving the lives of 20,000 firefighters.

Q: How can we help?

A: Call your representative and say, "Hey, we need to take care of our hometown heroes. We've got a crisis going on here."