The possibility of an H1N1 pandemic is quite properly receiving a great deal of policy and health system attention. This is not just a question of system preparedness and monitoring; the potentially unequal impact of any pandemic needs to be addressed from the outset:
- We need to analyze which groups within society are most vulnerable to getting infected. This is partially about viral properties, but it is also about pervasive inequalities of health and living conditions, as illustrated graphically by the recent experience of Manitoba First Nations.
- Then we need to analyze who is most vulnerable to serious illness once infected and to the disruptions inevitably caused by any pandemic; impact will be affected by both existing inequalities in health and the more limited capacities of under-resourced and poorly served communities to cope with major disasters. What will be the spread of infection within densely packed poor big city housing? Closing drop-ins, shelters and community agencies will be especially harmful to the most vulnerable.
- Finally, we need to analyze access to treatment and care. Speculation that people will be able to pay privately for quicker access to any vaccine should not be surprising. The cost of medications of all kinds is a huge barrier to those without good employment plans or unable to pay.
If these kinds of equity issues are not built into planning from the start, then any pandemic will massively reinforce existing inequalities of health.
Here are some helpful links provided by Thomas Appleyard, Principal, Preparedness, whose recent paper “Bridging the Preparedness Divide”, can be found here with accompanying Wellesley Institute policy analysis.
World Health Organization: Pandemic H1N1 2009
Canadian Pandemic Influenza Plan for the Health Sector
Ontario Health Plan for an Influenza Pandemic
Toronto Public Health Plan for an Influenza Pandemic
Toronto Public Health: A Planning Guide for Community Agencies
Toronto Public Health: A Planning Guide for Homeless and Housing Service Providers
Association of Ontario Health Centres: Preparation Guide for an Influenza Pandemic