Shot in the Arm

Though I only spoke Mandarin Chinese growing up, I found it cathartic, whenever I was angry, to curse in strings of expletives in Mandarin, Taiwanese and English under my breath.  But at the age of 10, I gave it all up.  It’s the only resolution I’ve kept 96% successfully for so long, to the point that when I do swear aloud now (usually to quote someone), it sounds stilted and unnatural.  I usually liken my loyalty to flu shots to my non-swearing habit: I get why you’re not like me.  No judgment here.  (Exceptions being doctors, elderly people, and others high-risk folks: the benefits outweigh costs for them and they should almost always get vaccinated). 

Our decisions to engage in protective actions like buckling up and buying insurance depend on the costs and likelihoods of the harm we want to avoid.  For many, their flu shot consideration (however brief) is something like this: 

Effectiveness x Cost of flu shot (pain, time, copay, etc.) > Risk x Cost of flu (medical expenses, lost wages, etc.)

Simply put, people choose not to vaccinate when cost > benefit.  Though getting the flu is miserable, costly, and leads to tens of thousands of deaths annually, it’s usually unlikely to touch healthy, attractive people like you.  However, the flu season is the worst in at least a decade.  Hospitals in Boston were so overwhelmed by influenza patients (more so than during the H1N1 outbreak) that the mayor declared a public health emergency.  The flu is now widespread throughout the US.  For those following the math, the risk of getting the flu is much higher than usual.  If you haven't gotten a shot: it's time to rethink your equation*.  

(The intensity this year surpasses the previous peak from H1N1.  
Click on the map to play with the google trends yourself.)

Of course, the risk of flu isn’t the only part of the equation that changes.  The cost of vaccination can be lowered to make shots more attractive.  Public Health likes that since the more people are vaccinated, the less likely it is for anyone to get the flu.  This is why flu shots are fully covered by many insurers, why employers set up workplace clinics, and why retail pharmacies don’t require appointments.   At Bowdoin College, the health center further sweetened the deal by giving Halloween goody bags with candies and toys, forever changing my attitude toward flu shots.  Whatever incentive works for you, the risk of flu is high this year and the cost of vaccination is low.  So for f*ck’s sake: get a flu shot.

*There is so much straightforward information on flu shots out there that I don't need to argue it here; the shot is effective and will not give you the flu.

Policy Implications:  Though the public benefit of flu shots is greater than that for individuals, incentives can spur individuals toward disease prevention.

Public Health in Public

Joy's Note:  A few weeks ago, I sat down to write the 'post-Sandy post' and quickly realized that I was not the right person for the job-- not when I knew a way-more-legit expert-in-training who has managed public health emergency response at the NYC Department of Health and Mental Hygiene, who has worked as an EMT, who is pursuing a PhD in health and public policy at Hopkins, and whose own family was dealing with post-Sandy flooding.  This post comes courtesy of Meghan McGinty, who has faced such formidable foes as Katrina, Rita, and H1N1.  Follow her musings about public health and risk communication on twitter @breukelen299:

When Joy began this blog, she intended it to be a forum to articulate, “what exactly public health is, why you should care, and what great, non-creepy things are happening while you're asleep.” In her first post, she highlights the live-saving activities of public health that often happen unbeknownst to the public. But over the past month, public health has made our lives safer and healthier in a very visible way.

On October 29th, Superstorm Sandy made landfall in Atlantic City, New Jersey, leaving a path of destruction up and down the east coast. Though the storm has passed, there are many hazards that remain in its aftermath. Public health workers are working tirelessly to ensure that the public is safe from the hazards posed by the consequences of the storm, namely the loss of power and flooding. Some of the most urgent health concerns included: access to safe drinking water, contaminated flood waters, food safety/sanitation and carbon monoxide poisoning from running generators without proper ventilation. In case you missed it, here is a brief overview of some of the essential public health services that have made us safer and healthier after Sandy:

What has public health done?                                    

• The US Department of Health and Human Services Secretary, Kathleen Sebelius, declared a public health emergency, which allowed Medicaid, Medicare and Children’s Health Insurance Program (CHIP) rules to be waived thereby ensuring that beneficiaries of these programs continue to receive critical healthcare services after Sandy.
• The US Public Health Service opened seven 40,000 square-foot Federal Medical Stations, which have 250 hospital beds for evacuees requiring non-emergency medical care.
• The New York City Department of Environmental Protection monitored public drinking water to ensure that tap water was safe to drink.
• The New York City Department of Health and Mental Hygiene visited numerous restaurants that lost power, were flooded, or had food contaminated to ensure that these restaurants were able to safely re-open.
• The NYC Health Department also issued warnings about:

o   Operating portable generators safely to avoid carbon monoxide poisoning;

o   Food and water safety/sanitation; and

o   Cleaning homes after flood damage. 

Delivery of these crucial public health services would not have been possible without the significant investment our Federal, state and local governments have made in developing and maintaining our public health infrastructure, as well as all the emergency preparedness planning that has been conducted for disasters like Sandy.  

What can you do?

Emergencies such as Superstorm Sandy can leave people feeling vulnerable and helpless. But there are important steps you can take to help us recover from Sandy and to protect yourself and your family from future disasters.  To help with recovery from Sandy, consider:

•  Donating blood;
•  Making a financial donation to the American Red Cross; or
•  Volunteering to help with the recovery. 

To protect yourself from future emergencies:

•  Be prepared to take care of yourself and your family for at least 72 hours; be informed, make a plan, build a kit, get ready (Joy's note: and don't eat your emergency rations unless it's an emergency!).
•  Heed evacuation orders. When you don’t, you put not only your life in danger, but also the lives of the first responders who have to save you.

Lastly, I urge you to communicate to your elected and appointed officials that you value government investment in emergency preparedness. Unless you are ready to sanitize your own water and grow your own food, you rely on public health to keep you safe. Public health and disaster relief cannot be left to the private sector.

--Meghan McGinty, MPH, MBA, CPH

(Meghan's thanks and disclaimers:

• I would like to express my gratitude to the many courageous first responders (including my brother-in-law), public health workers, and volunteers who have responded to and will continue to help us recover from the devastation of Superstorm Sandy.

• The views expressed within are entirely my own and do not reflect the opinions of Joy Lee or any organization with which I have previously been or currently am affiliated.)