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Pandemic influenza planning in the United States violates the demands of social justice in 2 fundamental respects: it embraces the neutrality of procedural justice at the expense of more substantive concern with health disparities, thus perpetuating a predictable and preventable social injustice, and it fails to move beyond lament to practical planning for alleviating barriers to accessing care.
A pragmatic social justice approach, addressing both health disparities and access barriers, should inform pandemic preparedness.
Achieving social justice goals in pandemic response is challenging, but strategies are available to overcome the obstacles. The public engagement process of one state's pandemic ethics project influenced the development of these strategies. (AmJ Public Health. 2012;102: 586-591. doi:10.2105/AJPH. 2011.300483)
HISTORICALLY, SOCIALLY DISadvantaged groups have fared the worst of any population during influenza pandemics.1-3 They will most likely continue to do so; this certainly held true for the 2009 influenza A (H1N1) pandemic. Although that pandemic was relatively mild, its disparate impact on certain populations raises significant ethical concerns. The US Centers for Disease Control and Prevention (CDC) acknowledges,
[I]t's clear that minority groups have consistently had higher rates of serious 2009 H1N1 disease, including hospitalizations, than non-minority groups. In fact, hospitalization rates among minority groups have consistently been more than double those of White, non Hispanics.4
Preliminary data analysis in Minnesota indicates that "nonwhites represented an astonishing 31% of hospitalized cases,"5 although they consititute only 11% of the population of the state.6 American Indian/Alaska Native populations in the United States had a death rate 4 times as high as all other racial/ethnic groups combined. 7We focused on pandemic preparedness in the United States, but similar disparities span the globe. For example, in Australia, New Zealand, and Canada, rates of hospitalization and death for 2009 H1N1 were 3 to 8 times as high in indigenous as in general populations. 8 Murray et al. contend that if a severe (1918-type) pandemic occurred today, "96% (95% CI 95-98%) of the estimated number of deaths would take place in the developing world."9(p2215)
CDC maintains that the reasons for racial/ethnic differences in hospitalization rates are unknown but suggests they may be attributable to socioeconomic factors such as "access to care, preponderance of underlying health conditions among certain ethnic or minority groups, and self care...