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Health Equity and Response to H1N1

January 21, 2010

By Ashley Bowen, Program Associate with NACCHO, Assigned to Local Health Department National Coalition for Health Equity

H1N1''s Impact on Minority Populations

 It is sometimes said that epidemics do not discriminate, that the flu virus infects for rich and poor, black and white, male and female alike. However, as more research and reports examine the H1N1 epidemic it is clear that some populations continue to be disproportionately impacted by diseases like H1N1. 

A December 2009 CDC Morbidity and Mortality Weekly Report found that Native Americans and Alaskan Natives were four times more likely to die from H1N1 than all other ethnic or racial groups combined. 

Cities such as Houston, Boston, Los Angeles, and New York recorded H1N1''s disproportionate impact on African American and Latino populations. 

Finding the Fundamental Causes

The virus itself may not discriminate, but the conditions in which one works, plays, and lives often determine a person''s ability to recover from H1N1 or a similar virus. 

Over the past several months members of the Local Health Department National Coalition for Health Equity, a NACCHO-sponsored group dedicated to addressing the fundamental causes of inequity in the distribution of disease, discussed their own observations on how H1N1 impacts different populations and what should be done about this.

Coalition members work with a variety of population groups such as Native American and Hispanic, from both rural and urban areas. Each department found that it confronted a unique set of challenges while trying to ensure that those with the least power (financially, politically, or otherwise) were adequately addressed in their H1N1 response. For example, several departments employed translators during vaccination clinics but quickly realized that this was not enough to assuage fears and dispel wild rumors about the vaccine. 

One member wrote that Latinos in her area had been told "that the vaccine formula provided to them was different (from different vials) than was provided to the non-Hispanic/Latino population, and only they would become ill from it." The department worked to quell this rumor, taking into account the historical reasons why particular populations may distrust an experimental vaccine or medical procedure and the department''s position as a government agency.

The more subtle cause of discrepancy is the relationship between H1N1 hospitalization and death rates and other underlying conditions. Media reports often focused on the higher rates of hospitalization that occurred in low-income minority communities. But few reporters asked why so many lower income and minority individuals had underlying diseases known to complicate H1N1 treatment, such as asthma and HIV/AIDS. Much research on the social determinants of health has documented the clear relationship between inequity and poor health which the H1N1 statistics sadly bring into sharp focus.  

There is little doubt that public health officials and LHDs did everything they could in this epidemic, and the response to H1N1 should be praised. Attempts to discuss health inequity in the H1N1 epidemic should not be read as accusations of outright bias on the part of individuals. Rather, these statistics and observations should serve as a reminder that public health is about more than vaccinations. To truly care for many populations requires acting on the underlying causes of chronic or infectious disease.

Have Your Voice Heard on These Issues

If you would like to join the conversation about how the social determinants of health impact epidemic response, please leave a comment below or join the Local Health Department National Coalition for Health Equity

The coalition is open to all local health departments and is dedicated to strengthening the organizational influence and capacity of LHDs toward that goal. If your health department would like to participate in ongoing conversations about equity''s relationship to H1N1 please join the coalition.

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Comments about this post

Anne pitcher
The disproportionate rate of children's deaths (3 times high this year than for the last 3 flu seasons, should encourage adults to have their children vaccinated and get vaccinated themselves to protect other children with whom they come in contact.
Anne Pitcher
The disproportionate rate of deaths among children (3 times higher than that of seasonal flu for the past three years, should be reason enough for adults to have their children vaccinated as well as being vaccinated themselves to protect any children with whom they come in contact.
Justine Uhlenbrock
The Wisconsin Department of Health Services & City of Milwaukee Health Department provided a document to address their inequity in H1N1 hospitalization rates