Embargoed Until:
July 7, 2009
12:01 a.m. Eastern Time



Christopher Fleming

How Well Did Health Departments Communicate About Swine Flu At The Start Of The Epidemic?

State Health Departments Provided Timely And Accessible Information, But Performance Varied Greatly Among Local Health Departments

Bethesda, MD -- After a public health emergency was declared, the overwhelming majority of state health departments provided timely, easily accessible information on their Web sites regarding H1N1 influenza, or “swine flu,” but the response of local health departments was mixed, according to a study by RAND Corporation researchers published today on the Health Affairs Web site. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w743

On Sunday, April 26, 2009, the U.S. Secretary of Health and Human Services declared a public health emergency in response to the outbreak of H1N1 influenza -- known as “swine flu” -- in the United States. Within 24 hours of this declaration, state health department Web sites in forty-six states and the District of Columbia had at least some information specific to H1N1 influenza, and all but two of the sites required at most one click to obtain basic content.

Forty-three state sites provided information for individuals on how to protect themselves and others (for example, frequent hand-washing and staying home when sick); fewer provided advice on when to seek treatment (36) or who should take antiretroviral drugs (27). Thirty states provided information for medical providers, either through their own content (14) or through linking to the Centers for Disease Control and Prevention (CDC) Web site (16). Slightly over half of the state sites included press releases.

On the second day after the HHS secretary’s emergency declaration, the RAND researchers re-examined the state health department Web sites that lacked information on swine flu in the first 24 hours after declaration. They found that all but one site had swine flu information posted within 48 hours.

“In general, state health departments did a good job in communicating information about a serious health threat to their constituents,” said lead author Jeanne Ringel, a senior economist with RAND in Santa Monica. “Still, there were areas of concern. Most notably, only nine states included information in languages other than English, despite the particular need for Spanish-language information in this case: The H1N1 virus originated in Mexico, and much of the discussion about the virus focused on border and immigration issues.”

More Than Half Of Larger Local Health Departments Provided Timely Information, But Only A Quarter Of Smaller Local Departments Did So

In contrast to the performance of state health departments, only 34 percent (52 out of 153) of the Web sites of local health departments provided any information specific to the H1N1 virus within a day after the secretary’s declaration, according to Ringel and coauthors Elizabeth Trentacost, an administrative assistant at RAND in Arlington, Virginia, and Nicole Lurie, who was a RAND senior natural scientist when the project was done. Just over half of the local health departments providing information did so by linking to the CDC or their state health departments, and only 14 percent posted a press release.

The RAND researchers examined a random sample of larger local public health agencies participating in the HHS “Cities Readiness Initiative.” They also looked at a random sample of local health departments in the five states that had confirmed swine flu cases at the time of the secretary’s declaration. More than half of the larger local health departments provided timely online information about the H1N1virus, but only a quarter of smaller departments did so. However, there was tremendous variation across the five states with confirmed cases: 73 percent of local health departments in California posted information on their Web sites within 24 hours after the secretary’s declaration, compared to only 8 percent of local health departments in Kansas and 18 percent in Texas.

“We don’t know for sure why there was so much variation at the local level in online communication about swine flu. Anecdotal reports suggest that many local health departments don’t see themselves as the primary provider of information, but in emergencies people -- particularly those in rural areas -- tend to look to local officials for guidance. Local health departments could also be communicating in other ways -- such as newspapers and television -- that weren’t captured in our study,” Lurie said.

Ringel and her colleagues conclude by noting that federal funding for public health emergency preparedness has declined in recent years. “This reduction in funding, coupled with the current economic crisis, has led many health departments to lay off staff and reduce their activities across the board (for both routine public health functions and emergency preparedness). Unfortunately, these cuts threaten to erase much of the progress that has been made over the past eight years and will likely lead to major degradations in U.S. preparedness and response capabilities,” the authors warn.

After the embargo lifts, you can read the article by Ringel and coauthors at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w743


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


©2009 Project HOPE–The People-to-People Health Foundation, Inc.