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Many Public Health Workers Wouldn't Work in a Pandemic, Study Suggests

Posted on: Monday, 17 April 2006, 21:00 CDT

By HELEN BRANSWELL

TORONTO (CP) - A disconcerting proportion of public health employees think their services would not be needed during an influenza pandemic and say they are unlikely to show up for work, a new study has found.

The study, based on a survey in the state of Maryland, reports that 46 per cent of public health workers were unlikely to report to work during a pandemic. Many erroneously thought staff who don't typically work in infectious disease containment operations would not be required during a disease emergency.

That underscores the need to educate staff in all facets of a public health organization - and the health system at large - that their help will be critical when a pandemic occurs, the lead author said.

"Training programs are usually focused at . . . increasing the workers' capabilities to perform their duties during an extreme event," said Dr. Ran Balicer, an epidemiologist at Ben-Gurion University of the Negev in Israel.

"But what we see here is that we should perhaps focus even more on increasing the willingness to come to work in the first place."

While the study focused only on public health workers, the findings suggest there are likely still gaps in understanding throughout the health delivery system of the roles people will need to play in a flu pandemic, said Dr. Allison McGeer, one of Canada's leading infectious disease specialists.

"I think most pandemic planners have assumed that people in public health departments know they're going to be needed," said McGeer, head of infection control at Toronto's Mount Sinai Hospital. She was not involved in this study.

"And the fact that a great majority of them don't know that is a marker for how much people need to learn about the response and how much discussion we need to have about the response."

The paper, authored by Balicer and three researchers at Johns Hopkins School of Public Health in Baltimore, was published Tuesday in the journal BMC Public Health.

The study has limitations. The sample size was small - 308 employees from three public health departments in a single U.S. state. And it was conducted from March to July last year, before the issue of pandemic flu hit the public radar in a serious and sustained fashion.

But the findings are statistically significant. And the data are among the first from which planners can attempt to glean an answer to a question they dread asking: Will workers in the health delivery system put themselves at risk by showing up for work when the system and society needs them most?

Some will and some won't, many planners assume, based on post-mortems done on the responses to crises like SARS.

It's been assumed personal safety and the safety of family are key factors health-care workers consider when making that decision. And this study supports the notion those issues will weigh heavily on deliberations.

But to his surprise, Balicer and his co-authors found that the single most important factor playing into the decision appears to be whether the employee felt his or her job was important to the operation and the response.

"They would feel that their personal safety is an issue on one hand and on the other hand, not all of them feel that the impact of their role would be significant enough to justify coming to work," Balicer said in an interview from Israel.

McGeer noted in most public health departments, the majority of staff aren't involved in battling communicable diseases and have no experience working a disease outbreak. Public health operations cover a lot of turf: healthy baby programs, pollution mitigation, chronic disease control.

But there will be an "all hands on deck" need during a flu pandemic - and that must be conveyed and understood before the event starts, said Toronto bioethicist Dr. Ross Upshur.

"If all the IT guys don't show up, it's going to completely hamstring your response," explained Upshur, a physician at Sunnybrook Health Sciences Centre and a researcher with the University of Toronto's Joint Centre for Bioethics.

Upshur is not an author of the study.

The study raises questions about how well others in the health delivery system have been brought into pandemic planning, McGeer suggested.

Some physicians, like plastic surgeons, won't be able to continue their normal operations during a pandemic and could be pressed into service to fill other roles. But many operate out of clinics; if they are not approached in advance and trained by hospitals, their services could go untapped during an emergency, she noted.

"I think overwhelmingly Canadians when faced with a crisis like this will pitch in and help," McGeer said.

"But if we're going to be asking people to do things that are different from what they normally do, they can't pitch in and help unless they know where they're going to be helpful."

Upshur said it's time for hospitals and public health departments to educate staff throughout their operations about the planned response to a pandemic.

"I think the message here is the need to get buy-in from virtually everybody in a complex health-care organization," Upshur said. "Which means that management needs to be incredibly proactive and win the hearts and minds in their planning."

Source: Canadian Press

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