Copyright © 2010 by the BMJ Publishing Group Ltd. All rights reserved.This study was sponsored by Canadian Institute of Health Research (CIHR), and
supported by the Community Coalition Concerned about SARS and other community organisations in the great Toronto area

Goodwin, R

Haque, S

Myers, L

Neto, F

Journal of Epidemiology & Community Health

English

Brunel University Research Archive

LETTERSInitial behavioural and attitudinalresponses to influenza A, H1N1(‘swine flu’)As the media interest in H1N1 Inﬂuenza A(‘swine ﬂu’) ebbs and wanes, it is importantto prepare ourselves for the societaldnot justthe medicaldimplications of this outbreak.While practitioners may, rightly, anticipatea desire for physical intervention (eg, facemasks),1 psychologists also point to thesocietal ‘out-grouping’ that can follow anepidemic. Often, when populations facea seemingly uncontrollable threat, they drawon existing stereotypes to reassurethemselves.2 Already there are reports of thenegative treatment and stereotyping ofMexicans following the outbreak in thatcountry.3 In our own recent data, collected inMalaysia from community members andstudents (n¼180) and in Europe via aninternet questionnaire (n¼148) ﬁve groups ofpeople were seen as at high risk of infection:the immune compromised (mentioned by87% respondents), pig farmers (70%), olderpeople (57%), prostitutes/highly sexuallyactive and homeless (both 53%). In addition,in Malaysia, 32% thought homosexuals alsoto be a high risk group (8% in Europe),primarily because they associate homosexu-ality with HIV infection, and thus weakenedimmunity.This tendency to focus on particular‘out-groups’ at risk can have importantconsequences. First, such associations withrisk can lead to increased prejudice towardsthose already marginalised by societies.During times of widespread threat, andpossible shortages, it is hard to imagine thatwill not lead to the rationing of vitalsupplies (eg, anti-viral drugs). Second, bylimiting our attention to particular groups,we can become far too optimistic about ourown mortality.4 This can then lead to bothpatients and practitioners failing to takeappropriate behavioural precautions. Never,therefore, has there been a more prescienttime for physicians to ‘know thyself ’. Nosocial group, however well trained, is freefrom bias, and this applies to medicalprofessionals too.5 Pandemic threats, suchas that posed by the current H1N1outbreak, have the rare ability to affecteveryone, even the ‘health young’ oftenrelatively unaffected by seasonal ﬂu.Engrained models of the vulnerable die hard,but if there was ever a time to challengethese, it is now.Robin Goodwin,1 Shamsul Haque,2 Felix Neto,3Lynn Myers11Social Sciences, Brunel University, Uxbridge,Middlesex, UK; 2School of Medicine and HealthSciences, Monash University Sunway campus, JalanLagoon Selatan, Bandar Sunway, Malaysia; 3Faculdadede Psicologia e de Ciencias da Educacao, Universidade doPorto, PortugalCorrespondence to Professor Robin Goodwin, SocialSciences, Brunel University, Uxbridge, Middlesex UB83PH, UK; robin.goodwin@brunel.ac.ukAll authors had full access to all of the data (includingstatistical reports and tables) in the study and can takeresponsibility for the integrity of the data and theaccuracy of the data analysis.RG is the guarantor for this submission.Contributors RG, SH and LM designed conceived theoverall project, and analysed the data along with SH andFN. LM and SH helped in data interpretation and FN infinal article drafting.Competing interests None.Provenance and peer review Not commissioned; notexternally peer reviewed.Accepted 25 June 2009J Epidemiol Community Health 2010;64:182e183.doi:10.1136/jech.2009.093419REFERENCES1. Jefferson T, Foxlee R, Del Mar C, et al. Physicalinterventions to interrupt or reduce the spread ofrespiratory viruses: systematic review. BMJ2008;336:77e80.2. Fischhoff B, Bruine de Bruin W, Perrin W, et al. Travelrisks in a time of terror: judgements and choices. RiskAnal 2004;24:1301e9.3. Barria C.Mexico battles ‘infected image’. BBC News 6May 2009. http://news.bbc.co.uk/1/hi/world/americas/8035802.stm.4. Weinstein ND. Unrealistic optimism aboutsusceptibility to health problems: conclusions froma community-wide sample. J Behav Med1987;10:481e500.5. Van Ryan M, Burke J. The effect of patient race andsocio-economic status on physicians’ perceptions ofpatients. Soc Sci Med 2000;50:813e28.Community mobilisation andempowerment for combatinga pandemicDuring the Severe Acute RespiratorySyndrome (SARS) outbreak, the ChineseTorontonians rallied behind variouscommunity organisations to address theirshared concerns. In order to efﬁcientlymobilise both human and material resourcesin the midst of the public health crisis, theCommunity Coalition Concerned aboutSARS was formed on April 14, 2003 shortlyafter SARS hits Toronto. The Coalitioncomprised 63 Chinese-Canadian business,community, cultural, religious and profes-sional organisations. Other Asian ethnicgroups including Japanese, Korean, SriLankan and Filipino, also joined force withthe Coalition in its subsequent operations.The community coalitions were able toquickly take action in a number of areas.They included: disseminating SARS relatedinformation in Chinese through printed andother forms of ethnic media, ﬁghting againstdiscrimination through advocacy, organisingevents to support frontline health workersand raise funds for research, organisingpromotional activities to help local busi-nesses, and operating community-basedtelephone support lines.1One of the most outstanding actions wasthe orchestration of the SARS telephonesupport lines, which offered a user-friendlyand linguistically and culturally appropriateservice to their community members. Withstrong collaboration with the I Love TorontoCampaign (a Chinese-speaking Taiwaneseorganisation), three lines were setup forserving the Chinese-Cantonese-speakingpopulation and the Chinese-Mandarin-speaking populations. Over 100 volunteerswere swiftly trained for the project, and theyreceived daily updates about SARS, backedup by Chinese-Canadian health professionalvolunteers. From 5 May to 13 June 2003, 268calls were handled, and most of the callerssought for emotional support and informa-tion/knowledge related to SARS.2The spirit of collective problem solvingempowered the Chinese community byfostering the sense that the community andits members could eventually assume controlover their own environment.3 4 Feedbackfrom coalition leaders, members and support-line volunteers alike showed that they andtheir families became less anxious about theepidemic as they regained a sense of controlthrough participation and reaching out tohelp others.5 The process of empowermentwas reﬂected among the Chinese communityleaders and volunteers, who became veryenthusiastic and active when playing theirimportant role in a public health crisis. Thelanguage-speciﬁc SARS Support Lines, bilin-gual SARS fact sheets, and other ethnicmedia projects proved to be effective in waysof: (1) Disseminating timely and updatedinformation concerning SARS in a linguisti-cally and culturally appropriate way; (2)Linking people-in-need to appropriateservices; (3) Empowering ethno-culturalcommunities at the crisis impact phase(dispelling myths, reducing fear and fosteringcommunity cohesiveness); (4) Increasing theeffectiveness of public containment policies;(5) Offering precise and accessible informa-tion about quarantine and the conditionsthat require quarantine; and (6) Identifyingindividuals at-risk and connecting them tomedical and formalised help.The success of these initiatives demon-strated the importance of having linguisti-cally and culturally appropriate channel forethnic communities to access informationand support in a time of crisis. In addition tobeing empowering, they proved to be effec-tive ways of disseminating time-sensitiveinformation, increasing the effectiveness ofpublic containment and quarantine policies,and identifying at-risk individuals to receivemedical and other appropriate help.The Toronto Chinese community ’s expe-rience shows that active engagement ofethnic communities can help combat infec-tious disease in critical times, and make the182 J Epidemiol Community Health February 2010 Vol 64 No 2PostScripthealthcare system more effective inresponding to public health challenge and thediverse needs of the society. This experienceis valuable for multicultural societies inpreventing and controlling any form ofpublic health crisis and beyond.Weizhen Dong,1 Kenneth Fung,2 Kar C Chan31University of Waterloo, Waterloo, Ontario, Canada;2Toronto Western Hospital, Toronto, Ontario, Canada;3Mount Sinai Hospital, Toronto, Ontario, CanadaCorrespondence to Professor Weizhen Dong,University of Waterloo, 200 University Ave W, Waterloo,Ontario N2L 3G1, Canada; weizhen@uwaterloo.caAll authors had full access to all of the data (includingstatistical reports and tables) in the study and can takeresponsibility for the integrity of the data and theaccuracy of the data analysis.RG is the guarantor for this submission.Acknowledgements This study was sponsored byCanadian Institute of Health Research (CIHR), andsupported by the Community Coalition Concerned aboutSARS and other community organisations in the greatToronto area. Sophia Ma and Kevin Lam providedresearch assistantship for the research project.Funding Canadian Institutes of Health Research, 160Elgin Street, 9th Floor, Address Locator 4809A, Ottawa,ON K1A 0W9, CANADA; Community Coalition Concernedabout SARS, 5183 Sheppard Avenue East, Scarborough,ON M1B 5Z5, Canada.Competing interests None.Ethics approval This study was conducted with theapproval of the University of Toronto.Provenance and peer review Not commissioned;externally peer reviewed.Accepted 15 August 2009J Epidemiol Community Health 2010;64:182e183.doi:10.1136/jech.2008.082206REFERENCES1. Community Coalition Concerned about SARS(CCCS). Written submission to the Ontario SARSCommission chaired by the Hon. Judge ArchieCampbell. 2003.2. Chan KC, Cheung C. SARS Support lines Report. 2003June 30.3. Rappaport J. Studies in empowerment: introductionto the issue. Prev Hum Serv 1984;3:1e17.4. Wallerstein N. Powerlessness, empowerment andhealth: implications for health promotion programs. AmJ Health Promot 1992;6:197e205.5. Dong W. Beyond SARS: ethnic communityorganization’s role in public health: a Torontoexperience. Promot Educ 2008;15:53e5.J Epidemiol Community Health February 2010 Vol 64 No 2 183PostScript

Beyond SARS: ethnic community organization’s role in public health: a Toronto experience. Promot Educ 2008;15:53e5.

Community Coalition Concerned about SARS (CCCS). Written submission to the Ontario SARS Commission chaired by the Hon. Judge Archie Campbell.

Powerlessness, empowerment and health: implications for health promotion programs.

SARS Support lines Report.

Studies in empowerment: introduction to the issue. Prev Hum Serv

Initial behavioural and attitudinal responses to influenza A, H1N1 ('swine flu')

Initial behavioural and attitudinal responses to influenza A, H1N1 ('swine flu')

Abstract

Similar works

Full text

Available Versions

Brunel University Research Archive

Repositório Aberto da Universidade do Porto

Crossref