Local Public Health Responses to the Threat of Pandemic Flu: Equitable Protection and Communities at Disproportionate Risk

Like politics, public health is always local. The Department of Health and Human Services (DHHS)/Centers for Disease Control and Prevention (CDC) echoes this view when discussiong preparation for pandemic influenza: "The local level is where the effects will be felt and where the response needs to occur." ¹ Public health agencies and professionals are in a prominent position when it comes to planning and response to pandemic influenza; they must ensure that core functions and essential services remain functional and that living conditions remain healthy. The purpose of this commentary is to reflect on the role of local health departments in preparing for pandemic influenza.

Local public health departments—of which there are over 2,500 of various sizes and shapes—can have responsibility for populations of towns, cities, and/or counties. Many are managed by physicians while others are not. Governance varies, with Boards of Health often having little or no direct authority to hire and fire directors and make local policy. However there is one significant constant: local health departments are the most likely source of the population-based services needed during an influenza pandemic. The local nature of agencies such as metropolitan or county departments of health makes it likely that the people employed there will understand the communities they serve and hold a position of trust in those communities. Such health departments are also likely to have established collaborative relationships with multiple different types of local organizations and agencies (e.g., community-based organizations [CBOs], faith communities, block associations, parent groups, advocacy groups). Local health departments are also likely to have built strong relationships with public safety, social service agencies and the media. As far back as the planning efforts for West Nile Virus in the mid-1990s, local health departments have engaged in community planning for health crises in terms of the core functions of public health at the local level: assessment, assurance, and policy development.

Increasingly, local health departments have also been intimately involved in addressing the issues associated with inequities in the health and health care system. They document inequities in health outcomes, incidence and prevalence of chronic diseases, and the percentage of populations without health insurance coverage. Some local health departments have been leading the movement to focus more intently on the social determinants of health and their causal role in persistent health inequities. For example, the Center for Health Equity at the Metro Louisville Department of Public Health and Wellness conducts ongoing work in addressing the basic issues around health inequities in the city of Louisville, Kentucky. The Center concentrates on communities that have been identified as being at increased risk, marginalized, and vulnerable. The Center also played a role in preparing these communities, which are projected to suffer the most in the event of pandemics, for an influenza pandemic.

Another local health department—in Madison and Dane County, Wisconsin—in Preparedness Through Linking All Neighbors (P.L.A.N.) lists the following as its goals: 1) to increase community based emergency preparedness, 2) to build and bridge social capital to improve community readiness and resiliency in an emergency, and 3) to promote health equity through awareness and dialogue. ² Health equity has several definitions. The best seems to be something like the following: "Health equity is the realization by ALL people of the highest attainable level of health. Achieving health equity requires valuing all individuals and populations equally, and entails focused and ongoing societal efforts to address avoidable inequalities by assuring the conditions for optimal health for all groups, particularly for those who have experienced historical or contemporary injustices or socioeconomic disadvantage." Health inequities have been defined as systemic, avoidable, unfair, and unjust differences in health status and mortality rates and in the distribution of disease and illness across population groups. They are sustained over time and generations and beyond the control of individuals.

Kayman and Adlorh-Odjidja, in their article published in the Journal of...