Slipping Through the Net: Social Vulnerability in Pandemic Planning (Policy & Politics‪)‬

In the spring of 2009, a number of U.S. schools closed in response to government health directives designed to prevent the transmission of the contagious respiratory influenza virus known as H1N1. Thousands of children were asked to stay home and avoid congregating in groups. Public health authorities asked ill workers to stay home. As spring stretched into summer, camps sent symptomatic children home. The traditional public health containment strategy known as "social distancing" has rippled throughout affected communities. Parents have been forced to risk their jobs, take unpaid leave, or use limited sick leave to care for housebound children. Children who typically rely on school or camp meal programs have gone without. Local businesses have suffered when workers and shoppers stayed home. These experiences are now being repeated in the southern hemisphere as H1N1 moves south, but with the added burdens and complications that come with the more limited infrastructures and fewer resources of the developing world. The public health efforts to stem a flu outbreak have potentially serious social ramifications. More importantly--and seemingly overlooked in pandemic planning for a virus such as H1N1--social context has major implications for the potential effectiveness of public health strategies to minimize morbidity and mortality and prevent the further spread of disease. For example, an undocumented restaurant worker receiving low wages and lacking job security and health benefits may have no real choice but to continue working through an illness, and may avoid seeking medical attention that he cannot afford and fears might lead to deportation. The worker's life situation makes it both impractical and inadvisable to respond to well-intentioned but unrealistic public health directives, putting both restaurant workers and diners at risk of infection. Policies that fail to take into account the realities of individuals' lives and the social contexts in which they live cannot hope to succeed. The accomplishment of the public health goal of minimizing the effects of outbreaks may depend in significant part on social vulnerabilities that affect an individual's or community's capacity to respond to public health directives.