April 2008

Grant Results

SUMMARY

Between September 2006 and February 2007, researchers at the Center on Social Disparities in Health at the University of California, San Francisco, examined ways in which different socioeconomic and racial/ethnic groups might fare in the event of an influenza pandemic and recommended approaches to reducing inequities and adverse health outcomes.

Key Findings

  • Governmental plans for addressing influenza pandemics can fail if they do not consider socioeconomic and racial/ethnic disparities in exposure, vaccination and treatment, or identify strategies for minimizing or eliminating such disparities.
  • The Pandemic Influenza Plan of the U.S. Department of Health and Human Services makes only limited mention of how to minimize disparities in exposure, vaccination and treatment among racial, ethnic and socioeconomic groups.

Braveman and her team issued a number of recommendations based on the research. See Recommendations.

Funding
The Robert Wood Johnson Foundation (RWJF) provided a $43,044 grant for this project.

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THE PROBLEM

Major influenza pandemics have occurred every 10 to 30 years for the last several centuries. Many believe a new pandemic is "inevitable," according to the World Health Organization. The appearance of avian influenza has heightened that concern.

The poor and disadvantaged often suffer disproportionately during natural disasters and epidemics; for example, the poor fared considerably worse than the rich during the 1918 pandemic in the United States (Sydenstricker E., Public Health Report, 2006: 121 Supplement, 1: 191–204).

More recently, in the wake of Hurricane Katrina, planners apparently failed to consider that many poor people might not have cars and would need government or other sources of transportation to follow evacuation orders.

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RWJF STRATEGY

RWJF has three comprehensive and integrated objectives in public health:

  • Improving the performance and impact of public health agencies.
  • Increasing advocacy for public health resources and policy changes that improve the public's health.
  • Building an evidence base for effective public health practice and policy.

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THE PROJECT

Paula Braveman, M.D., M.P.H., at the Center on Social Disparities in Health and her colleagues examined ways in which different socioeconomic and racial/ethnic groups might fare in the event of an influenza pandemic. They also recommended approaches to reducing inequities and adverse health outcomes.

Through a review of the literature, the researchers examined three levels at which socioeconomic or racial/ethnic differences could lead to disparities in illness or death resulting from an influenza pandemic:

  • Likelihood of exposure to the influenza virus.
  • Likelihood of developing influenza once exposed.
  • Likelihood of receiving timely and effective treatment after influenza is developed.

Researchers originally planned to quantify disparities by race, ethnicity and socioeconomic status in the event of a pandemic. They were unable to do so because not enough is known about the properties of any virus to make quantifiable estimates about morbidity or mortality.

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FINDINGS

The researchers reported the following findings in an article (see the Bibliography) in press in a peer-reviewed journal (Blumenshine P, Reingold A, Egerter S, Mockenhaupt R, Braveman P, Marks J. "Pandemic Influenza Planning in the United States From a Health Disparities Perspective." Emerging Infectious Diseases, May 2008):

  • Governmental plans for addressing influenza pandemics can fail if they do not consider socioeconomic and racial/ethnic disparities in exposure, vaccination and treatment, or identify strategies for minimizing or eliminating such disparities.
    • Low-income people and racial/ethnic minorities are more likely to be exposed to an influenza virus than non-poor or white people because they are more likely to live, congregate, travel or work in crowded conditions.
    • Lower wage/lower status workers are more likely to be exposed because they typically are less able to work at home and more likely to send their children to school or day care during an epidemic.
    • Socially disadvantaged groups may be more likely to develop influenza, particularly severe disease, during an epidemic. However, it is uncertain how factors such as age, smoking or nutritional status, cardiopulmonary disease or type of influenza virus influence susceptibility.
    • Low-income people and racial/ethnic minorities may be less likely to have access to timely and appropriate care after they develop influenza. This is due to a lack of access to medical care in general and logistical obstacles such as lack of transportation or language barriers.
  • The Pandemic Influenza Plan of the U.S. Department of Health and Human Services makes only limited mention of how to minimize disparities in exposure, vaccination and treatment among racial, ethnic and socioeconomic groups.

Recommendations

In their article in press in Emerging Infectious Diseases, a peer-reviewed journal, the researchers recommended that, in order for influenza plans to anticipate the effects of an influenza pandemic on low-income people and ethnic/racial minorities, the following steps must be taken:

  • Pandemic influenza plans should explicitly acknowledge that unless protocols address disparities in exposure, susceptibility and treatment, social disparities in influenza morbidity and mortality are highly likely to occur.
  • Public officials should systematically consider the additional barriers faced by socially disadvantaged groups at each of these levels and actively seek ways to address those barriers. For example:
    • Vaccine distribution protocols should address the need to reach groups that might not otherwise receive vaccines in a timely manner.
    • Plans to ensure equal access to evaluation, referral and treatment for severe influenza must consider such factors as lack of health insurance or citizenship, or language or cultural barriers.
  • Local service providers, leaders of community-based organizations and other organizations working with socially vulnerable groups and leaders of labor unions representing low-wage service workers are likely to have valuable insights and should be included in the planning process.

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GRANT DETAILS & CONTACT INFORMATION

Project

Preparation and Dissemination of a Paper on a Flu Pandemic: Would Some People Suffer More Than Others?

Grantee

University of California, School of Medicine, San Francisco (San Francisco,  CA)

  • Amount: $ 43,044
    Dates: September 2006 to February 2007
    ID#:  057738

Contact

Paula A. Braveman, M.D., M.P.H.
(415) 476-6839
Braveman@fcm.ucsf.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Blumenshine P, Rengold A, Egerter S, Mockenhaupt R, Braveman P and Marks J. "Pandemic Influenza Planning in the United States From a Health Disparities Perspective." In press; Emerging Infectious Diseases, May 2008. Abstract available online. Full article available prior to publication online.

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Report prepared by: Mary Nakashian
Reviewed by: Angela Bonavoglia
Reviewed by: Robert Narus
Reviewed by: Molly McKaughan
Program Officer: Robin E. Mockenhaupt

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