Public Health Gaps

The H1N1/09 outbreak raises several policy implications, both global and local. The pandemic commonly known as swine flu demonstrates the urgent need for a holistic approach to urban public health; with the majority of the world’s population now living in cities, the urban dimension should be a primary focus of public health, requiring a localized, site-specific approach. Strengthening local public healthcare systems must become a priority that involves improving the development and distribution of reliable information about the causes and transmission of the virus.

'Visualizing' health

Visual research and spatial analysis can support the health care needs of urban communities and strengthen public health systems. Visualizing epidemiological data such as health statistics and using information diagrams to educate populations and inform decision-makers is crucial for external pageurban public health researchcall_made.

Mapping the virus’ transmission routes could inform the debate on how best to respond. Apart from biological transmission, little is known about the route the virus is traveling, the factors exacerbating flu onset or its main modes of movement. Research and analysis through mapping could provide insight into the transmission and spread of the epidemic in urban areas.

Maps and visuals can disseminate complex information in a clear, concise manner, while educating populations and raising awareness – a key component of public health preparedness. Mapping with geographic information systems (GIS) or even through simple, participatory cartography, can visualize (and make visible) infection sources, epidemic clusters and transmission routes. Overlaying maps with different information can highlight the varied factors contributing to disease outbreaks as well as the location of resources to address them. These visuals provide effective, easily communicated evidence for health policy and advocacy efforts.

The Indian government, for example, plans to map H1N1 transmission by documenting the movement patterns of individuals in the city of Pune. This process will include assessing the severity of the illness, the speed with which it spreads and how long the infection is likely to last. This response demonstrates how low-cost solutions are crucial, effective and achievable.

Swine flu maps are currently available to the public from numerous sources. external pageHealthmapcall_made, for example, uses data to create an up-to-date global disease alert system. The external pageBBCcall_made also offers maps and information diagrams.

Visual and spatial analysis also has several practical benefits in terms of vaccine deployment. In Yemen, for example, USAID has used GIS to map vaccine stocks and dispensing locations.

Yet, countries like the US – site of the highest number of cases and fastest transmission – are focusing efforts on developing vaccines as the primary public health mode of preventing a swine flu outbreak.

Public health for profit

The US federal government’s response has been to increase the availability of flu-fighting medicines and authorize $1billion to develop a new vaccine, reflecting a healthcare system driven by profit rather than human health. The US aims to stock 160 million doses of swine flu vaccine for October, even though manufacturers worldwide are still facing problems with the drug's developmental stage.

Forbes external pagereportscall_made that the H1N1 virus has been “good news” for UK pharmaceutical company GlaxoSmithKline, with investors hoping to “cash in on the rapidly growing market for swine flu medications and vaccines.”

With the creation and deployment of vaccines often linked to profit-making, it is usually developing countries that suffer most. The drugs’ expense and inaccessibility is exacerbated by the WTO external pageTRIPScall_made agreement, for instance, which limits generic drug manufacturing in developing countries. This limitation has potentially dramatic consequences for these countries, where a level six pandemic is more likely to spread rapidly.

A vaccine, however, is not a ‘magic bullet’ for this epidemic. While the external pageWHOcall_made notes that flu vaccines are the most effective means of protecting people and preventing illness during flu epidemics, preventive measures like social distancing and personal hygiene and treatments like anti-viral drugs are also necessary.

Additionally, research has not definitely demonstrated that a vaccine will be safe for children, and there is always a risk of long-term side effects. Reports of a polio external pageoutbreakcall_made in Nigeria highlight the long-term risks of some vaccines. And a recent online external pagearticlecall_madesignals possible problems with an H1N1 vaccine, while raising questions about media reliability and the risk of generating mass hysteria by releasing information out of context.

Common sense dictates that simple, cultural and site-specific hygiene measures are critical to battling the pandemic. Priority should be given to raising local awareness and making tools available for populations to protect themselves from illness.

Think global, act local

Efforts to combat this pandemic should focus on resource allocation, contextualization and dissemination of information to the public. The outbreak illustrates the link between health and education and highlights the importance of planning globally while acting locally. All levels of government ought to collaborate and explore the intersection of urban planning with the environmental and social determinants of health; such findings should be implemented at the local level.

Urban health systems and capacities must be strengthened. Local authorities should map appropriate resources for tackling the pandemic and make their findings available online. Citizens could then know where, for example, to go to get respirators; H1N1 case clusters could be charted to promote awareness without violating privacy. This information would also help people better understand how transmission is occurring, or what sections of a city should be avoided. Local authorities could also use the maps to focus scarce resources on areas most in need of attention.

Current pandemic treatment efforts must not ignore the underlying problem: the lack of a responsive, appropriate public health system for urban communities at the local level. The goal of these systems should be to promote human health and security – not serve as a market for profit-making. Visual and spatial analysis can inexpensively, innovatively and effectively engage and educate populations, raise awareness about how to simply and effectively prevent transmission, protect health and strengthen global social networks. The focus should be on creating public-awareness campaigns in urban areas. Attention must be paid to schools where children are vulnerable to transmission and to public spaces where urban populations tend to cluster – chief among them transportation hubs like subways, train stations and airports.

The proliferation of a global yet intensely localized swine flu pandemic signals limitations in public health systems and disease outbreak preparedness. Stockpiling vaccines and doling out Tamiflu is not the solution. Strengthening local health systems and empowering individuals with information to protect themselves should become the priority.