Preparing for a Pandemic

Albert Ruesga’s comments about the lessons we have (or have not) learned from Katrina are right on. For anyone who has visited New Orleans after Katrina, it is patently clear that the poor - including the working poor - who still live there continue to suffer. There is one clinic in all of St. Bernard’s parish, operated by Franciscan Missionaries of Our Lady Health System. This clinic tends to the needs of the elderly, those trying to renovate their homes. Sit in the waiting room for even one hour and you will witness saddness and despair, as well as tremendous heroism on the part of both patients and providers.

In a pandemic, those who have cash, computers, faxes, etc. will be able to stay home and avoid contact with those infected. This is not true of the millions of persons struggling just to tred water financially.

Hospitals, particularly those in poor, inner-cities are already struggling beyond the breaking point. Ruesga’s urging of bolstering of the safety net for the poor is absolutely correct. Although I do not have much hope that this will happen in the near future.

Furthermore, as an ethicist, I am keenly aware that the ethical community is still pondering, even agonizing over the terrible decisions that medical personnel had to make during Katrina.

Hospitals, clinics, urgent care centers and physicians offices are not sufficiently prepared to make ethical decisions necessary in a pandemic. This is not to say that health care professionals are not moral persons, but, for the most part, we live in a time of “rescue medicine.” The Iraq War has advanced medical skills in this area, saving the lives of many soldiers. Physicians and nurses see their vocation to save patients. Triage in a pandemic will be quite different than in an ordinary ER situation.

Hospitals and clinics can and are educating their staffs about the probability of this disaster. But we need the help of the media to get the message out to the public that this will not be “medicine as usual.”

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Americans Should Get Ready For Flu

Experts agree that we are long overdue for the next flu pandemic, and concerns persist. A 5-year-old girl died in Indonesia last week from avian flu, raising the country’s H5N1 death toll to 77. Vietnam this week confirmed its first case of human bird flu - a 30-year-old man from the northern Vinh Phuc province - since 2005. And the World Health Organization, recently adopted a resolution to help countries better prepare for a flu pandemic.

Many of us have mobilized to help educate Americans about the importance of preparing. But too few have heeded our call. The American Public Health Association (APHA) released a poll in April, that found that almost 90 percent of the general public say they have not taken enough steps to prepare for a public health crisis and know they could do more. The lack of preparations is particularly high among vulnerable communities such as mothers of young children, people with health conditions such as diabetes and high blood pressure and hourly wage workers who live from paycheck to paycheck. For example:

· 58 percent of mothers of children age five and younger do not have a three-day supply of water on hand for their family;· Only 61 percent of chronically ill people have at least a two-week supply of medications; and
· Only 18 percent of employers say they could continue to pay all their employees if there were an interruption in operations, and just 15 percent of hourly workers have saved enough money to provide for their families in such an event.

These stats are sobering. To help address some of these challenges, APHA, launched the Get Ready campaign, to provide information, resources and tools for individuals, families and communities to prepare for a potential flu pandemic and other health emergencies.

One feature of this campaign is the “Get Ready For Flu” blog. The blog is a discussion forum on pandemic flu that provides advice for the public on how to prepare for flu. Recent entries have covered egg and chicken safety, pets and avian flu and the development of flu vaccines.

Helping individuals, families and communities prepare for pandemic flu also provides protection in the event of other health emergencies such as blizzards, tornadoes, hurricanes and acts of terrorism. It’s an “all-hazards preparedness” approach that gives our preparedness dollars more bang for their buck and protects families and communities from a broad range of health threats.

When it comes to preparing for pandemic flu, the question is not whether we should be ready, but how can we afford not to be prepared?

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Lessons From Katrina

As with most natural disasters, a flu pandemic will not be an equal opportunity killer.

The winds and rains of Hurricane Katrina buffeted the just and the unjust, the black and the white.  The storm wasn’t selective about the structures it destroyed.

But it didn’t affect all populations equally.  The poor, the elderly, and the infirm were hardest hit, populations least able to shelter properly, or flee, or recover from the storm’s devastating effects.

Likewise, while a flu pandemic can affect anyone, at any income level, those of us who are not already weakened by food insecurity, who have access to quality health care, who can afford to stay home from work to avoid infection—have a much better chance of surviving.

In 2004 there were 46 million uninsured people in the United States, most of them poor or low-income.  Eleven percent of U.S. households in 2005 were food insecure.  According to the Bureau of Labor Statistics, there were 6.4 million working poor in 2000; by 2003 that number had grown to 7.4 million.

I applaud the efforts of the Department of Health and Human Services to help Americans prepare for an influenza pandemic.  But as I see it, the most effective way to help those in the lowest income brackets prepare for this tragedy is to urge this and all Administrations to bolster—rather than dismantle—the safety net for the poor.

The President’s 2008 budget proposed deep reductions in domestic discretionary spending to continue financing tax cuts for those of us who are well-off.  According to the Center for Budget and Policy Priorities:

The discretionary programs in the budget subfunction known as “health care services” include community health centers, HIV/AIDS programs (for U.S. residents), maternal and child health programs, the Indian Health Service, substance abuse and mental health treatment …  This subfunction is slated for $2.5 billion in cuts over the next five years, relative to the expected fiscal year 2007 funding level adjusted for inflation.  The cuts would reach $861 million, or 4.1 percent, in 2012.

The President’s budget also included a provision that would cut the Food Stamp Program by $740 million over the next five years, taking more than 300,000 low-income people off the program in an average month.

If we want to help all Americans prepare for the inevitable flu pandemic, what’s the sense in decreasing, rather than increasing, the resiliency of our most vulnerable neighbors?  What, if anything, did we learn from the experience of Hurricane Katrina?

_____

Albert Ruesga blogs on foundations and nonprofits at White Courtesy Telephone.

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ANA Joining the Dialogue

As the President of the American Nurses Association, I am pleased to join in this signficant discussion on a real threat to our country and the world. We know that as registered nurses we must be ready to respond, both personally and professionally. Being prepared does not apply only to those of us who respond at the time of need, — all citizens must take this seriously and begin to plan for any potential disaster that may occur in our own community. It is true that many families are already stretched and finding the time and money to do this will not be easy. However, there are consequences of not doing so — consequences for individuals, families, communities, states and countries.

Comments have already been posted expressing concern about our health care system being quickly overwhelmed and healthcare workers being unable or unwilling to come to work. This may be true. But, as we continue to plan and work together, we can consider ways to improve the response of the health care system before a disaster. For instance, one strategy might be to change where we birth most babies. This might seem trivial, if not unconnected, to disaster preparedness. But consider: Most pregnant women experience a healthy pregnancy. Plans should be made now to expand opportunities for out-of-hospital home or birthing-center deliveries. These is no need for healthy pregnant women to go to a hospital already overwhelmed by influenza patients. These deliveries can and should be attended by certified registered nurse midwives already based in the community.

With regard to health care workers and their ability or willingness to come to work during a pandemic influenza event. We know that this is tied to their concerns for their families and their own personal health. These are reasonable concerns and could be managed with appropriate planning on the part of the government, the employer, and the health care worker. For instance, it is critical that we work together to ensure that there are sufficient supplies of respirators and other personal protective equipment. If we attend to these concerns in advance, then we know that registered nurses and other health care workers are much more likely to come to work and provide excellent care.

I look forward to participating in a very lively and productive dialogue.

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Preparing for Persuasion

We don’t know exactly what a flu pandemic will look like or when it will come, but we do know enough to be able to put systems in place so that we’re ready. Because we will not be able to rely on the government to take care of everyone when the pandemic comes, we need to make sure that citizens, schools, businesses and other organizations are prepared beforehand and take appropriate actions to mitigate its effects throughout its duration. How do we persuade people to do the right thing?

Generally, governments and organizations have used three ways to bring about social change or action on a broad scale. First, through education — telling people the facts and hoping they will do the rational thing to protect their families and others. Providing lists of supplies, statistics about likely morbidity and mortality, and medical symptoms are all part of the educational approach. Unfortunately, as we know from issues like smoking and exercise, knowledge is often not sufficient to bring about behavior change. Second, coercion by passing laws or enacting policies at the governmental or organizational levels can be very effective. This method might be necessary to enforce quarantines, but we can’t very well legislate the purchase of an adequate supply of emergency food by each household. The third approach is social marketing, persuading people to take action by appealing to their values and emotions by “selling” the desired behaviors using the same effective techniques as companies like Apple or Nike.

Social marketing brings about change by promoting the benefits that are most appealing to members of the target audience, whether it’s that pandemic preparedness is just another way to be a good parent or that other people like themselves have already bought their supplies and think they should too. It also focuses on identifying the reasons why people are not taking action and figuring out ways to remove those barriers — packaging supplies in an easy-to-buy kit, relating pandemic preparedness to planning for more familiar natural disasters (e.g., earthquakes, hurricanes, etc.), or using the flu epidemic of 1918 as a way of making the potential devastation less abstract.

When most people hear the word “marketing,” they think of things like commercials and billboards. Yes, communication is usually a big part of marketing, but it is just a piece of the puzzle. The marketing approach also offers us a strategic way to think through all the aspects of convincing someone to take action. Some of the questions we would need to answer include:

• Who are each of the key groups who need to take action? (e.g., parents, seniors, school administrators, local government officials, business managers, etc.)
• What exactly do you want each of those groups to do? (e.g., purchase a 2-week supply of food and water for each member of their families, practice good hygieine habits, have a formal school closure plan that will be triggered by a particular threshold, etc.)
• What are the key practical or emotional benefits that would motivate each of these groups? (e.g., feelings of responsibility, desire for social acceptability)
• What are the barriers to taking action, and how can we remove those barriers? (e.g., not seeing flu pandemic as real threat, hassle of buying all the supplies)
• What are the times and places we can best reach each audience, particularly when they may be thinking about flu, family health, or disaster preparedness issues? Are there places they may be in a position to take action? (e.g., at a home supply store, at a pharmacy)
• What are some of the methods we can use to reach each of the audiences with our messages? (e.g., online social networks, blogs, Oprah, school district newsletters)
• Who are the spokespeople that are seen as most credible by each audience? (e.g., local officials, doctors, peers)
• Who are the partners that we need to hook up with in order to best reach each audience? (e.g., doctors, “mommy bloggers,” media organizations)

Now is the time, before the pandemic comes, to set good habits, get supplies in place, and establish social norms around the actions that will help people survive. We may not want to even necessarily talk about these things in the context of a flu pandemic, if we find that this concept is too foreign for people to connect with, but relate it to general emergency preparedness or good health habits. I see a parallel with the hype and hysteria around global warming, which makes many people tune out when its proponents could more effectively convince people to take energy saving measures for more concrete reasons like reducing our dependence on foreign oil or preventing environmental damage.

I will admit that I am not an expert on pandemic flu, so I will now turn it over to the rest of you for your comments. How do you think we can apply the strategic issues I’ve posed here to marketing pandemic flu preparedness?

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