PoPulationand Public HealtH etHics

practice
Decision making
While the philosophical doctrines discussed above may inform public health
decision making, they are not the only criteria against which to evaluate possible
responses to the conditions described in this case. A recent review of
resource allocation during an H1N1 pandemic noted that, “it is especially important
for there to be dialogue between the general public, government and
healthcare decision-makers since having the public abide by recommendations
requires trust among all interested parties. And in the case of pandemic
influenza, everyone is an interested party.” 6 This observation raises two key
questions about future pandemic planning in Canada: which stakeholders
must be represented and what role should they play in the planning process?
While the quotation above suggests that “everyone” is a stakeholder, this
case illustrates how different communities may have very different stakes
and interests in pandemic planning. In this case, it is clear that representatives
of First Nations communities must play a significant role in pandemic
planning. In a practical sense, they can improve planning by alerting public
health organizations about the particular resource constraints their communities
face, thus preventing future problems such as the recommendation of
frequent hand washing in a community without running water. From the
point of view of justice, they can advocate for increased attention to health
inequalities that may disadvantage their communities, including placing the
alleviation of these resource constraints on the public health agenda.
Given that First Nations communities have a clear stake in future pandemic
planning, what might their actual participation entail? In a limited sense,
they must obviously play a role in selecting, designing and implementing
interventions targeted at First Nations communities. But what about the distribution
of pandemic planning resources more generally? Does the fact that
First Nations communities suffered health inequalities during the last pandemic
justify a seat at the table in pandemic planning? As a comparison, we
might note that women suffered disproportionate morbidity and mortality
in the H1N1 pandemic. The 2009 study notes that females comprised 67.3%
of hospital admissions and 72% of deaths, despite only making up roughly
50% of the Canadian population. If First Nations communities deserve representation
in pandemic planning by virtue of their greater vulnerability to
H1N1, then it stands to reason that women — who make up a much larger
PoPulation anD Public HealtH etHics
162