PoPulationand Public HealtH etHics

for individuals living in substandard, overcrowded homes where infectious
diseases are more likely to spread.
Public health emergencies such as the 2009 H1N1 pandemic highlight governments’
ethical responsibilities towards vulnerable populations. Most people
recognize that the government had a responsibility to provide the H1N1 vaccine.
But the consequences of poverty, such as inadequate water supply and
overcrowded housing, created difficulties for an adequate pandemic response
within Aboriginal communities. Canada’s response to the pandemic could
have been improved had the government taken responsibility for alleviating
these poverty-based health inequities prior to the outbreak.
While many of the negative experiences of the spring outbreak improved
Canada’s response in the fall outbreak, poor living conditions such as overcrowding
and a lack of running water were not addressed. 14-16 Instead,
responses to the fall outbreak included large shipments of body bags to
many remote First Nations communities, with a negative and well-publicized
reaction. 12 During the spring and summer outbreak, more than one-quarter
(25.6%) of the approximately 168 patients admitted to hospitals across Canada
for H1N1 influenza were of Aboriginal ancestry, 13 even though they make up
only about 4% of the Canadian population. 17 In remote communities, high
rates of H1N1 infection also placed significant pressure on air ambulance services,
with 76 patients requiring medivac services from northern Manitoba
alone at the cost of $5,000 per patient. 18
Scenario shift
Consider whether the circumstances of this case would be different if:
» a non-Aboriginal remote community experienced high rates of H1N1
infections, serious cases and deaths from a lack of clean running water
and basic sanitation;
» the government invests funding to build a tertiary care facility accessible
to surrounding First Nations to provide more cost-effective health
services in remote communities. However, no additional funds are
provided to improve housing, sanitation and water systems. Would
this be an improvement?
Health Inequities in First Nations Communities and Canada’s Response to the H1N1 Influenza Pandemic
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